Surgical options for male stress incontinence

Male Slings

Male sling is a device designed to support the muscles around the Urethra to its proper anatomical position for optimal sphincter function, restoring urinary control. It is highly effective, minimally invasive procedure to correct mild to moderate incontinence (one to two pads a day with normal daily activities).

The male sling from American Medical System (AMS) is a safe and effective surgical solution for mild to moderate incontinence. The sling is placed inside the body. It places pressure upon the urethra, reducing the possibility of urine leakage and providing urinary control. It works on its own and requires no manipulation from you.

It offers many benefits to men suffering from urinary incontinence. It is an outpatient procedure performed under spinal or general anesthesia. Recovery is very rapid allowing you to resume non-strenuous activities within a few days.

Finally, 20 to 30% of men following prostate cancer surgery seen in my practice have leakage of urine with orgasm. This can be a very frustrating symptom, which can interfere with a healthy sexual life. The male sling will alleviate and for some completely eliminate the urinary incontinence associated with orgasm.

InVance™ Male Sling

Procedure:

Spinal or general anesthesia can be used

Small incision under the scrotum

Miniature titanium screws placed into the pubic bone on each side of the urethra

Sling positioned to exert gentle pressure on urethra

Sling secured to screws

Incision closed

AdVance™ Male Sling

Procedure:

Spinal or general anesthesia can be used

Three small incisions: 1 under the scrotum, 2 over groin creases

Specially designed surgical tools are used to position the sling

Sling is gently tightened

Incision closed

Artificial Urinary Sphincter (AUS)

The Gold Standard for treatment of moderate to severe incontinence

60 minute outpatient procedure

92% of patients would have the device placed again

96% of patients would recommend it to a friend

Device is placed completely in the body, providing simple, discreet control

The Artificial Urinary Sphincter is placed inside the body to provide urinary control. The sphincter is closed unless the control pump, which is located inside the scrotal sac, is squeezed. This opens the sphincter cuff temporarily for a few minutes allowing urination. The cuff then closes automatically. It has proved to be highly effective in treating male incontinence following prostate surgery. Most men are left dealing with only very minor leaks, usually resulting from exertion or strenuous exercise. You can stay dry by using a pad a day or less to manage these minor leaks. It is not 100% effective in all patients and they may require additional protection. Placement of a second urethral cuff will improve incontinence in most cases.

The Artificial Urinary Sphincter 800, produced by American Medical System has been used successfully for almost 30 years. It is an outpatient procedure, performed under spinal anesthesia. The procedure lasts about 45-90 minutes. Shaped like a doughnut the device is implanted around the neck of your bladder. The fluid filled ring keeps your urinary sphincter shut tight until you are ready to urinate. To urinate you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to be released.

As with any procedure, you may experience some temporary pain afterwards. This is considered normal and can be usually treated with oral medication. Recovery time varies from patient to patient. You can resume normal physical activity within a few days of the procedure or as directed by your doctor. The device can typically be used 6to 8 weeks after the procedure. Once the sphincter is activated you can control your own urination by squeezing the control pump whenever you need to empty the bladder.

According to peer reviewed recent publications in the Journal of Urology (December 1996):

90% of patients reported satisfaction with their sphincter 800

92% would have the sphincter 800 placed again

96% would recommend the sphincter 800 to a friend

Complications include malfunction of the device, which means that the surgery will need to be repeated and infection, but infection is uncommon. In a clinical study of people with an urinary sphincter 800:

Less than 5% experienced an infection

Less than 4% experienced cuff erosion into the urethra

Less than 5% experienced device failure

All these problems can be successfully treated when addressed in a timely manner.

Incontinence and impotence following prostate cancer surgery

Should one do both the Artificial Urinary Sphincter and the Penile Implant at the same time?

In my 27 years experience with over 5000 penile prosthesis and sphincters, I believe that it is not prudent, nor advantageous for the patient to have both done simultaneously. Performing both together will increase operating time. It is well established that the longer the surgery, the higher the risk of infection. Should an infection occur in one device, the other will most likely also get infected. In addition a much greater amount of edema and post-operative swelling will occur after the procedure when both implants are combined. This will delay the use of both implants and may compromise the placement of the penile sphincter control pump and impact overall outcome. Finally proximal placement of the artificial sphincter urethral cuff is compromised by using the same scrotal incision for the penile implant, which negatively affects the success of the sphincter: the patient will continue to leak urine.

Dr. Eid discusses a patient that has conquered prostate cancer and has now cured his ED and urinary incontinence with an inflatable penile prosthesis (IPP) and an artificial urinary sphincter (AUS).

What to do first a Penile Implant or the Artificial Urinary Sphincter and why?

When considering both implants, the penile and artificial sphincter, the penile implant should always be performed first. The reason for this is that once the penile implant is inserted, proximal (close to the bladder) placement of the urethral cuff or cuffs becomes much easier. Also the sphincter is a more delicate device and insertion of a urethral catheter (usually needed to perform the penile implant) should be avoided. Finally if the sphincter is done first, then it will need to be deactivated temporarily at the time of penile prosthesis placement in order to allow the penile implant pump to heal in the scrotum. The patient will be incontinent again during this process. The best option therefore is to do the penile implant first, wait three months and then perform the artificial urinary sphincter.

A prosthesis specialist should be consulted to determine if you are the right candidate for these procedures. If you suffer from any of the symptoms of incontinence, you should consult with a Urologist who specializes in prosthetic surgeries to determine the best possible treatment option for you.